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Infertility

Causes of infertility

Infertility can be caused by many different factors. Around a third of infertility is due to problems with the woman, and another third is due to problems with the man. In 23% of cases, a cause cannot be identified.

Infertility in women

Ovulation disorders

Infertility is most commonly caused by problems with ovulation (the monthly release of an egg). Some of these problems stop women releasing eggs at all, and some cause an egg to be released during some cycles, but not others.

Ovulation problems can occur as a result of a number of conditions, listed below.

Premature ovarian failure, where a woman’s ovaries stop working before she is 40.

Chronic (long-term) conditions. Some chronic conditions, such as cancer, or AIDS, can prevent your ovaries from releasing eggs.

Cushing’s syndrome, a rare hormonal disease that can prevent your ovaries from releasing an egg.

Womb and fallopian tubes

The fallopian tubes are the tubes along which an egg travels from the ovary to the womb. The egg is fertilised as it travels down the fallopian tubes. When it reaches the womb, it is implanted into the womb's lining where it continues to grow.

If the womb or the fallopian tubes are damaged, or stop working, it may be very difficult to conceive naturally. This can occur following a number of factors, outlined below.

Pelvic surgery

Pelvic surgery can sometimes cause damage and scarring to the fallopian tubes.

Cervical surgery

Cervical surgery can sometimes cause scarring, or shorten the cervix (the neck of the womb).

Cervical mucus defect

When you are ovulating, the mucus in your cervix becomes thinner so that sperm can swim through it more easily. If there is a problem with your mucus, it can make it harder to conceive.

Submucosal fibroids

Fibroids are benign (non-cancerous) tumours that grow in, or around, the womb. Submucosal fibroids develop in the muscle beneath the inner lining of the womb wall and grow into the middle of the womb.

Submucosal fibroids can reduce fertility, although exactly how they do this is not yet known. It is possible that a fibroid may block one of your fallopian tubes, or prevent an egg from implanting itself into your womb.

Endometriosis

Endometriosis is a condition where small pieces of the womb lining, known as the endometrium, start growing in other places, such as in the fallopian tubes or the ovaries.

This can cause infertility because the new growths form adhesions (sticky areas of tissue) or cysts (fluid-filled sacs) that can block or distort the pelvis. These make it difficult for an egg to be released and become implanted into the womb.

Endometriosis can cause infertility because it can disturb the way that a follicle (fluid-filled space in which an egg develops) matures and releases an egg.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the upper female genital tract, which includes the womb, fallopian tubes, and ovaries. It is usually a sexually transmitted infection (STI). PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb.

Sterilisation

Some women choose to be sterilised if they do not wish to have any more children.

Sterilisation involves blocking the fallopian tubes to make it impossible for an egg to travel to the womb. This process is rarely reversible, and if you do have a sterilisation reversed, it will not necessarily mean that you will become fertile again.

Medicines and drugs

The side effects of some types of medication and drugs can affect your fertility. These medicines are outlined below.

Non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use, or a high dosage, of NSAIDs, such as ibuprofen or aspirin, can make it more difficult for you to conceive.

Chemotherapy. The medicines that are used for chemotherapy (a treatment for cancer) can sometimes cause ovarian failure, which means that your ovaries will no longer be able to function properly. Ovarian failure can be permanent.

Neuroleptic medicines are antipsychotic medicines that are often used to treat psychosis. They can sometimes cause missed periods or infertility.

Spironolactone is a medicine that is used to treat heart failure, and can cause irregular periods and infertility.

Illegal drugs such as marijuana and cocaine can seriously affect your fertility, making ovulation (the monthly cycle where an egg is released from the ovaries) more difficult. Drugs may also adversely affect the functioning of your fallopian tubes.

Age

Infertility in women is also linked to age. The biggest decrease in fertility begins during the mid thirties. For women who are 35, 95% will get pregnant after three years of having regular unprotected sex. For women who are 38, only 75% will get pregnant after three years of having regular unprotected sex.

Infertility in men

Semen

Abnormal semen (the fluid containing sperm that is ejaculated during sex) is the most common cause of male infertility. Abnormal semen accounts for 75% of male infertility cases. Some possible reasons for abnormal semen are listed below.

Decreased number of sperm. You may have a very low sperm count, or no sperm at all.

Decreased sperm mobility. If you have decreased sperm mobility, it will be harder for your sperm to swim to the egg.

Abnormal sperm. Sometimes sperm can be an abnormal shape, making it harder for them to move and fertilise an egg.

Many cases of abnormal semen are unexplained, but there are several factors that can affect semen and sperm.

Testicles

The testicles are responsible for producing and storing sperm. If they are damaged, it can seriously affect the quality of your semen. This may occur if you have, or have had in the past, any of the following:

Absence of sperm

Your testicles may produce sperm, but it may not reach your semen. The absence of sperm in your semen is known as obstructive azoospermia. This could be due to a blockage in one of the tiny tubes that make up your reproductive system, which may have been caused by an infection or surgery.

Sterilisation

A vasectomy is the surgical procedure for male sterilisation. It involves cutting and sealing off the vas deferens (the tubes that carry sperm out of your testicles), so that your semen will no longer contain any sperm. A vasectomy can be reversed, but reversals are not usually successful.

Ejaculation disorders

Some men experience ejaculation problems that can make it difficult for them to ejaculate. Other ejaculation problems include:

retrograde ejaculation, where semen is ejaculated into your bladder

premature ejaculation, where ejaculation occurs too quickly

Hypogonadism

Hypogonadism is an abnormally low level of testosterone, the male sex hormone that is involved in making sperm. This could be due to a tumour, taking illegal drugs or Kallman’s syndrome (a rare disorder that is caused by a faulty gene).

Medicines and drugs

Sulfasalazine, an anti-inflammatory medicine used to treat conditions such as Crohn's disease (inflammation of the intestine) and rheumatoid arthritis (painful swelling of the joints). Sulfasalazine can decrease the number of sperm, but its effects are only temporary and your sperm count should return to normal when you stop taking it.

Anabolic steroids, which are often used illegally to build muscle and improve athletic performance. Long-term use, or abuse, of anabolic steroids can reduce your sperm count and your sperm mobility.

Chemotherapy. The medicines that are used in chemotherapy can sometimes severely reduce your production of sperm.

Herbal remedies. Some herbal remedies, such as root extracts of Tripterygium wilfordii (a Chinese herb), can affect the production of sperm or reduce the size of your testicles.

Alcohol

Drinking too much alcohol can damage the quality of your sperm. Guidelines published by the National Institute of Clinical Excellence (NICE) state that if men follow the Department of Health’s recommendations of drinking no more than three to four units of alcohol a day, it is unlikely that their fertility will be affected. However, drinking more than this could make it difficult to conceive.

Factors that affect both men and women

As well as factors that specifically affect a man or a woman’s fertility, there are also a number of factors that can affect fertility in both men and women. These are outlined below.

Weight

Being overweight, or obese, reduces both male and female fertility. In women, being overweight can affect ovulation. Being underweight can also have an impact on fertility, particularly for women, who will not ovulate if they are severely underweight.

Sexually transmitted infections (STIs)

There are several sexually transmitted infections (STIs) that can cause infertility. For example, chlamydia can damage the fallopian tubes in women, and cause swelling and tenderness of the scrotum (the pouch containing the testes) in men.

Smoking

As well as affecting your general and long-term health, smoking can also adversely affect fertility.

Occupational and environmental factors

Exposure to certain pesticides, metals, and solvents can affect fertility in both men and women.

Stress

If either you or your partner are stressed, it may affect your relationship. Stress can reduce libido (sex drive) which in turn can reduce the frequency of sexual intercourse. Severe stress may also affect female ovulation and limit sperm production.

OvulationOvulation is when an egg is released from a woman's ovaries.

OvariesThe ovaries are two small, round organs in the female reproductive system that release an egg every month.

Thyroid glandThe thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism.

Fallopian tubesThe tubes connecting the ovaries to the womb.

Womb The womb (or uterus) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

TesticlesThe testicles are part of the male reproductive system. They produce sperm and are located within the scrotum (a loose bag of skin) hanging down behind the penis.

SemenSemen is the fluid released when a man ejaculates. It is made up of sperm produced in the testicles plus fluid from the prostate and seminal vesicle glands.

EjaculationEjaculation is the squirting out of semen from the penis during an orgasm (sexual climax).